Stroke remains the most disabling of any neurological disease, as well as one of the leading causes of death in the United States. The annual incidence of strokes in the US is now neariy 750,000 and the most recent cost estimates of stroke care have been calculated as a staggering $50 billion. Over the next decade, the impact of stroke is likely to increase. The aging of our population and the changing race-ethnic composition could lead to an increased stroke incidence, mortality, morbidity and cost. The only approved acute therapy for stroke is IV tPA. Despite the excellent 3-month outcomes among those acute stroke patients treated within 3 hours, IV tPA is used in only 3-4% of patients suffering from stroke in the US. Part of the explanation for the inadequate penetration of IV tPA into stroke treatment stems from the public's lack of recognition of acute stroke symptoms, as well as the lack of infrastructure at the hospital level to expeditiously detect, triage and treat acute stroke patients.(1) In a North Carolina survey, 66% of hospitals did not have stroke protocols, and 82% did not have systems for rapid identification of acute stroke.(2) The Brain Attack Coalition of the American Heart Association has made recommendations for the establishment of primary stroke centers, and has more recentiy published a set of guidelines for the establishment of comprehensive stroke centers.(3-5) Based on these recommendations and a general awareness among interested participants, the acute stroke team is the cornerstone of the stroke center and consists of an interdisciplinary group of experienced healthcare workers dedicated to the delivery of eariy stroke care.(6) The 24-hour team coverage must be capable of responding rapidly to the need for diagnosing and managing acute stroke patients in the ER, as well as the hospital. Someone from the stroke team should be at the bedside within 15 minutes of being called.(7) Written treatment protocols are needed and have been shown to improve care of stroke patients and reduce IV tPA complications.(8-11) Such protocols should include the emergency care of stroke pafients, including eariy stabilization, initial diagnostic approaches, and the use of treatments that are based on guidelines or developed by the stroke team.(12) In recent years great strides have been made in understanding the pathophysiology of ischemic stroke and testing and applying treatments for acute stroke aimed at reducing morbidity and mortality after stroke. Despite these advances, too few acute stroke patients are benefiting from these treatments. There is a gap in the ability to implement the successes of clinical trials to the treatment of stroke in the community. Two major goals of SPOTRIAS are to promote access to existing therapies through the enhancement of Stroke Center systems, and to develop new therapeufic approaches for acute stroke intervention.